NSG 3800 Exam 4 V3 | NSG 3800 Nursing Practice – Adult Health II |
Actual Q&A with Rationale (NSG3800 Exam 4) | Galen
1. A patient is admitted in the compensatory stage of shock. Which clinical manifestation
should the nurse prioritize during assessment?
A. Significant hypotension
B. Tachycardia and cool skin
C. Metabolic acidosis
D. Anuria
Answer: B
Rationale: In the compensatory stage of shock, the body activates the sympathetic nervous
system to maintain cardiac output. This results in an increased heart rate (tachycardia) and
peripheral vasoconstriction, which manifests as cool, clammy skin. Blood pressure typically
remains within normal limits initially due to these compensatory mechanisms.
2. Using the Parkland formula, calculate the fluid requirement for the first 8 hours for a 75 kg
patient with 40% TBSA burns.
A. 3,000 mL
B. 12,000 mL
C. 6,000 mL
D. 4,500 mL
Answer: C
Rationale: The Parkland formula is calculated as 4 mL x weight in kg x % TBSA. For this
patient, the total 24-hour fluid requirement is 4 x 75 x 40, which equals 12,000 mL. Half of
this total volume (6,000 mL) must be administered within the first 8 hours following the
burn injury.
3. A patient with Acute Kidney Injury (AKI) enters the oliguric phase. Which electrolyte
imbalance is the nurse most likely to observe?
A. Hypokalemia
B. Hypercalcemia
C. Hypophosphatemia
D. Hyperkalemia
Answer: D
,Rationale: During the oliguric phase of AKI, the kidneys are unable to excrete metabolic
waste products and electrolytes effectively. Potassium levels rise because the kidneys are
the primary route for potassium excretion from the body. This hyperkalemia is dangerous
as it can lead to lethal cardiac arrhythmias and requires close monitoring.
4. Which positioning is most beneficial for a patient in hypovolemic shock to increase venous
return?
A. Modified Trendelenburg
B. High Fowler’s
C. Reverse Trendelenburg
D. Prone
Answer: A
Rationale: The modified Trendelenburg position involves elevating the patient’s legs to a
20-degree angle while keeping the head flat. This position uses gravity to assist venous
return from the lower extremities to the central circulation. It is preferred over standard
Trendelenburg because it does not compromise respiratory excursion by crowding the
diaphragm.
5. A patient is diagnosed with Septic Shock. Which laboratory value is the most sensitive
indicator of cellular hypoxia and anaerobic metabolism?
A. Blood Urea Nitrogen (BUN)
B. White Blood Cell Count
C. Serum Lactate
D. Hemoglobin
Answer: C
Rationale: Serum lactate levels increase when cells shift from aerobic to anaerobic
metabolism due to inadequate oxygen delivery. In sepsis, elevated lactate is a key marker
for tissue hypoperfusion even if blood pressure is still compensated. Monitoring lactate
trends helps clinicians evaluate the effectiveness of fluid resuscitation and oxygenation
strategies.
6. In the emergency department, a nurse triages a patient with a tension pneumothorax.
What color tag should be assigned?
A. Green
B. Yellow
C. Red
D. Black
, Answer: C
Rationale: Red tags are assigned to patients with immediate life-threatening injuries that
are treatable with rapid intervention. A tension pneumothorax causes obstructive shock
and respiratory failure, requiring immediate needle decompression. Without this rapid
care, the patient’s condition will deteriorate into cardiac arrest.
7. A patient with Diabetic Ketoacidosis (DKA) is receiving an insulin drip. What is the nurse’s
priority action when the blood glucose reaches 250 mg/dL?
A. Stop the insulin infusion
B. Increase the insulin infusion rate
C. Administer a bolus of IV potassium
D. Change the IV fluid to include 5% dextrose
Answer: D
Rationale: When blood glucose drops to 250 mg/dL in DKA, dextrose is added to the IV
fluids to prevent a sudden drop in glucose that could lead to cerebral edema. This allows
the insulin infusion to continue safely to resolve the ketosis. Resolving the metabolic
acidosis is the ultimate goal, not just lowering the blood sugar.
8. Which assessment finding is characteristic of a patient experiencing Neurogenic Shock
following a spinal cord injury?
A. Tachycardia and hypertension
B. Bradycardia and hypotension
C. Tachycardia and diaphoresis
D. Hyperthermia and shivering
Answer: B
Rationale: Neurogenic shock occurs due to the loss of sympathetic tone, leading to massive
vasodilation and an unopposed parasympathetic response. This results in the classic triad
of hypotension, bradycardia, and a loss of temperature regulation. Unlike other forms of
shock, the heart rate does not increase because the sympathetic pathways are disrupted.
9. A patient has a high-pressure alarm sounding on their mechanical ventilator. Which action
should the nurse take first?
A. Check for a leak in the ventilator tubing
B. Auscultate breath sounds and assess for obstruction
C. Silence the alarm and call the physician
D. Increase the tidal volume setting
Actual Q&A with Rationale (NSG3800 Exam 4) | Galen
1. A patient is admitted in the compensatory stage of shock. Which clinical manifestation
should the nurse prioritize during assessment?
A. Significant hypotension
B. Tachycardia and cool skin
C. Metabolic acidosis
D. Anuria
Answer: B
Rationale: In the compensatory stage of shock, the body activates the sympathetic nervous
system to maintain cardiac output. This results in an increased heart rate (tachycardia) and
peripheral vasoconstriction, which manifests as cool, clammy skin. Blood pressure typically
remains within normal limits initially due to these compensatory mechanisms.
2. Using the Parkland formula, calculate the fluid requirement for the first 8 hours for a 75 kg
patient with 40% TBSA burns.
A. 3,000 mL
B. 12,000 mL
C. 6,000 mL
D. 4,500 mL
Answer: C
Rationale: The Parkland formula is calculated as 4 mL x weight in kg x % TBSA. For this
patient, the total 24-hour fluid requirement is 4 x 75 x 40, which equals 12,000 mL. Half of
this total volume (6,000 mL) must be administered within the first 8 hours following the
burn injury.
3. A patient with Acute Kidney Injury (AKI) enters the oliguric phase. Which electrolyte
imbalance is the nurse most likely to observe?
A. Hypokalemia
B. Hypercalcemia
C. Hypophosphatemia
D. Hyperkalemia
Answer: D
,Rationale: During the oliguric phase of AKI, the kidneys are unable to excrete metabolic
waste products and electrolytes effectively. Potassium levels rise because the kidneys are
the primary route for potassium excretion from the body. This hyperkalemia is dangerous
as it can lead to lethal cardiac arrhythmias and requires close monitoring.
4. Which positioning is most beneficial for a patient in hypovolemic shock to increase venous
return?
A. Modified Trendelenburg
B. High Fowler’s
C. Reverse Trendelenburg
D. Prone
Answer: A
Rationale: The modified Trendelenburg position involves elevating the patient’s legs to a
20-degree angle while keeping the head flat. This position uses gravity to assist venous
return from the lower extremities to the central circulation. It is preferred over standard
Trendelenburg because it does not compromise respiratory excursion by crowding the
diaphragm.
5. A patient is diagnosed with Septic Shock. Which laboratory value is the most sensitive
indicator of cellular hypoxia and anaerobic metabolism?
A. Blood Urea Nitrogen (BUN)
B. White Blood Cell Count
C. Serum Lactate
D. Hemoglobin
Answer: C
Rationale: Serum lactate levels increase when cells shift from aerobic to anaerobic
metabolism due to inadequate oxygen delivery. In sepsis, elevated lactate is a key marker
for tissue hypoperfusion even if blood pressure is still compensated. Monitoring lactate
trends helps clinicians evaluate the effectiveness of fluid resuscitation and oxygenation
strategies.
6. In the emergency department, a nurse triages a patient with a tension pneumothorax.
What color tag should be assigned?
A. Green
B. Yellow
C. Red
D. Black
, Answer: C
Rationale: Red tags are assigned to patients with immediate life-threatening injuries that
are treatable with rapid intervention. A tension pneumothorax causes obstructive shock
and respiratory failure, requiring immediate needle decompression. Without this rapid
care, the patient’s condition will deteriorate into cardiac arrest.
7. A patient with Diabetic Ketoacidosis (DKA) is receiving an insulin drip. What is the nurse’s
priority action when the blood glucose reaches 250 mg/dL?
A. Stop the insulin infusion
B. Increase the insulin infusion rate
C. Administer a bolus of IV potassium
D. Change the IV fluid to include 5% dextrose
Answer: D
Rationale: When blood glucose drops to 250 mg/dL in DKA, dextrose is added to the IV
fluids to prevent a sudden drop in glucose that could lead to cerebral edema. This allows
the insulin infusion to continue safely to resolve the ketosis. Resolving the metabolic
acidosis is the ultimate goal, not just lowering the blood sugar.
8. Which assessment finding is characteristic of a patient experiencing Neurogenic Shock
following a spinal cord injury?
A. Tachycardia and hypertension
B. Bradycardia and hypotension
C. Tachycardia and diaphoresis
D. Hyperthermia and shivering
Answer: B
Rationale: Neurogenic shock occurs due to the loss of sympathetic tone, leading to massive
vasodilation and an unopposed parasympathetic response. This results in the classic triad
of hypotension, bradycardia, and a loss of temperature regulation. Unlike other forms of
shock, the heart rate does not increase because the sympathetic pathways are disrupted.
9. A patient has a high-pressure alarm sounding on their mechanical ventilator. Which action
should the nurse take first?
A. Check for a leak in the ventilator tubing
B. Auscultate breath sounds and assess for obstruction
C. Silence the alarm and call the physician
D. Increase the tidal volume setting
